1114072907 NPI number — JOHNSBURG CENTRAL SCHOOL

Table of content: PATRICK KIRK O'DELL FNP (NPI 1538727078)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114072907 NPI number — JOHNSBURG CENTRAL SCHOOL

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JOHNSBURG CENTRAL SCHOOL
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1114072907
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
165 MAIN STREET
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NORTH CREEK
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
12853-2304
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
518-251-2921
Provider Business Mailing Address Fax Number:
518-251-2562

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
165 MAIN ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NORTH CREEK
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
12853-0380
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
518-251-4201
Provider Business Practice Location Address Fax Number:
518-251-4201
Provider Enumeration Date:
01/24/2007

Additional Information

Authorized Official

Authorized Official Last Name:
DURKEE
Authorized Official First Name:
AMANDA
Authorized Official Middle Name:
Authorized Official Title or Position:
CSE CHAIRPERSON
Authorized Official Telephone Number:
518-251-4201

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 01379831 , issued by the state of ( NY ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2026 www.npivalidator.com